Understanding and Managing Coccydynia, Piriformis Syndrome, and Related Pain Conditions

At Horizon Spine & Pain of Utah, we know how frustrating and life-limiting chronic lower back, buttock, and pelvic pain can be. Whether it's pain when sitting, radiating discomfort down the leg, or stiffness after activity, conditions like coccydynia, piriformis syndrome, and related musculoskeletal disorders can significantly affect your mobility, mood, and quality of life. Our expert team is here to identify the source of your pain and offer effective, non-surgical treatments to help you feel like yourself again.

These pain conditions primarily affect the pelvic floor, lower spine, buttock, and hip region, and often involve inflammation, muscle dysfunction, or nerve compression:

• Coccydynia is pain in the tailbone (coccyx) area, typically worsened by sitting or transitioning from sitting to standing.
• Piriformis syndrome is caused by irritation or compression of the sciatic nerve by the piriformis muscle, located deep in the buttock. This leads to sciatic-type pain down the leg.
• Related conditions may include sacroiliac joint dysfunction, ischial bursitis, pelvic floor tension, or referred pain from the lumbar spine or hip.

While these conditions differ in origin, they can present with overlapping symptoms and are often misdiagnosed—making expert evaluation critical.

These painful syndromes often develop due to overuse, trauma, or biomechanical imbalances. Common causes include:

• Falls or trauma to the tailbone or pelvis
• Prolonged sitting, especially on hard surfaces
• Repetitive movements or lifting
• Hip, back, or pelvic misalignment
• Muscle imbalances or tightness (especially in the gluteal and pelvic muscles)
• Pregnancy or childbirth
• Poor posture or improper body mechanics

Risk factors include:

• Sedentary lifestyle or occupations with long sitting periods
• Previous pelvic or spinal surgery
• Uneven leg length or gait abnormalities
• Participation in sports involving twisting or repetitive hip movements

Coccydynia Symptoms:

• Localized pain at the base of the spine (tailbone)
• Pain worsens with sitting, especially on hard surfaces
• Tenderness when leaning back or rising from a chair
• Swelling or bruising after trauma

Piriformis Syndrome Symptoms:

• Deep aching pain in the buttock
• Sciatic-like symptoms: burning, tingling, or numbness radiating down the leg
• Pain worsens with sitting, climbing stairs, or hip rotation
• Sensation of tightness or spasms in the buttock

Related Conditions May Cause:

• Referred lower back or groin pain
• Sacroiliac joint stiffness or instability
• Pain during certain activities like walking, bending, or exercising

If left untreated, these conditions can become chronic and affect your everyday comfort and function.

At Horizon Spine & Pain of Utah, we take a thorough and personalized approach to diagnosis, which includes:

• Comprehensive medical history and symptom review
• Physical examination to assess posture, mobility, and muscle tenderness
• Orthopedic and neurological testing to rule out spinal causes
• Imaging studies:
  • X-rays or MRI to check for fractures, disc issues, or soft tissue damage
• Diagnostic injections:
  • Local anesthetic injections can help confirm the source of pain by providing temporary relief

Correct diagnosis allows us to tailor the most effective and least invasive treatment plan for you.

Most patients experience significant relief from conservative therapies. Our treatment plans often include:

Medications:

• NSAIDs, muscle relaxants, or neuropathic pain medications (e.g., gabapentin)

Physical therapy:

• Stretching and strengthening routines to address pelvic alignment, core stability, and muscle imbalances

Manual therapy and myofascial release

Posture and movement retraining:

• Ergonomic education for sitting, lifting, and movement patterns

Cushioning and activity modification:

• Use of coccyx cushions or wedge seats to reduce pressure
• Limiting aggravating activities during flare-ups

Injection therapy:

• Corticosteroid or anesthetic injections into the piriformis muscle, sacroiliac joint, or coccyx area for inflammation control

These therapies are designed to reduce pain, restore movement, and improve your quality of life without surgery.

For more persistent or severe cases, we offer advanced, image-guided treatments such as:

• Botox injections:
  • Used to relieve piriformis muscle spasms and reduce nerve compression
• Pulsed radiofrequency ablation:
  • Targets irritated nerve roots or joints to modulate pain signaling
• Nerve blocks:
  • For cases with significant sciatic or referred nerve pain

Our minimally invasive approach prioritizes pain relief with faster recovery times and minimal disruption to your lifestyle.

Surgery is rarely needed but may be considered in cases where:

• Structural issues (fractures, tumors, severe degeneration) are identified
• Conservative and interventional treatments have failed
• Nerve compression from anatomical anomalies requires decompression

Our team works closely with surgical specialists when appropriate, always ensuring non-surgical options are explored first.

Patients trust Horizon Spine & Pain of Utah because we offer:

• Board-certified providers with expertise in musculoskeletal and nerve pain
• Comprehensive diagnostics and evidence-based treatment strategies
• Minimally invasive and regenerative therapies
• Patient-centered care plans designed to meet your goals and lifestyle
• Compassionate support every step of your recovery journey

We're here to help you move better, sit comfortably, and return to the life you love—without chronic pain holding you back.